1366630360 NPI number — CENTRO DE MEDICINA PRIMARIA BAYAMON INC

Table of content: MISS BETH STANTON RPH (NPI 1922252543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366630360 NPI number — CENTRO DE MEDICINA PRIMARIA BAYAMON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE MEDICINA PRIMARIA BAYAMON INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366630360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1168 CALLE FINLANDIA
Provider Second Line Business Mailing Address:
URB. PLAZA DE LAS FUENTES
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953-3809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-269-9944
Provider Business Mailing Address Fax Number:
787-269-9944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D54 AVE LAUREL
Provider Second Line Business Practice Location Address:
URB. SANTA JUANITA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-9944
Provider Business Practice Location Address Fax Number:
787-269-9944
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-269-9944

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  173571 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9090173 . This is a "HUMANA GOLD CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3834 . This is a "PMC PREFERRED MEDICAL CHO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 22373 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 500437 E . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0022373 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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